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HIV/AIDS and Chronic Kidney Disease

What is HIV/AIDS?

Human immunodeficiency virus (HIV) is a replicating virus or retrovirus that can lead to acquired immunodeficiency syndrome (AIDS). AIDS is a health condition that causes the immune system to fail, which leads to a number of life-threatening infections and complications. HIV is transmitted when infected body fluid such as blood, semen, vaginal fluid and breast milk come into contact with a mucous membrane or the bloodstream of another person. While HIV and AIDS medicines help slow the progression of the virus, there is no cure for HIV or AIDS.

How does HIV/AIDS affect the kidneys?

HIV-related kidney problems are commonly known as HIV-associated nephropathy (HIVAN). Up to 30 percent of people with HIV or AIDS have protein in their urine, a sign of abnormal kidney function, and about 10 percent of people with HIV develop kidney disease. This means HIV patients make up 1 to 2 percent of the end stage renal disease (ESRD) population.

Renal problems related to HIV can be caused directly by the HIV virus when it enters the kidneys and multiplies or by the medicines patients must take to manage HIV. Highly active antiretroviral therapy (HAART) and other HIV treatments have side effects that can sometimes be toxic to the kidneys, including:

  • lactic acidosis — a build up of lactic acid in the body
  • crystal-induced obstruction — a build up of crystals in the kidneys
  • interstitial nephritis — a disorder in which tissues surrounding the kidneys become inflamed
  • electrolyte abnormalities — abnormalities in the body’s levels of sodium, potassium or calcium

Getting tested for chronic kidney disease (CKD)

Most chronic kidney disease symptoms show up only after a large part of your kidney function has been lost. These symptoms can include leg or facial swelling, changes in urination, fatigue and loss of appetite. Because CKD symptoms can be confused with other health problems, it’s often difficult to quickly diagnose kidney disease.

The most common test to see if the kidneys are working like they should is a urine test where a dipstick is used to check levels of protein, sugar, ketones, blood, nitrites and red and white blood cells. Nearly one-third of all people with HIV have high levels of protein in their urine, which can be a sign of possible kidney trouble. If protein is detected, your doctor may order more detailed kidney tests such as blood urea nitrogen (BUN) or creatinine clearance tests.

A BUN test is a blood test that checks for nitrogen in the blood. Nitrogen is produced by the body when protein is metabolized. Since nitrogen is normally removed from the body by healthy kidneys, high levels of nitrogen in the blood can mean the kidneys are not working as they should.

A creatinine clearance test is a combination of a blood test and a urine test that measures the kidneys’ ability to get rid of waste. Creatinine is created by the body when muscle is broken down. If this test shows low levels of waste in the blood and urine, it may mean the kidneys are not working like they should.

Treatment for chronic kidney disease (CKD)

HIV-positive patients who have or are at risk for chronic kidney disease should have their treatment tailored to their needs and circumstances. Some treatments for chronic kidney disease include managing phosphorus levels, reducing blood pressure, managing fluid balance and/or antiretroviral therapy.

The six classes of antiretroviral medications approved by the Food and Drug Administration are: Nucleoside reverse transcriptase inhibitors (NRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs), Entry inhibitors, Fusion inhibitors and Integrase inhibitors.

  • Nucleoside reverse transcriptase inhibitors (NRTIs) bind to and disable reverse transcriptase, a protein that HIV needs to make more copies of itself.
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) create faulty versions of building blocks that HIV needs to make more copies of itself. When HIV uses one of these faulty building blocks instead of a normal building block, reproduction of the virus is stalled.
  • Protease inhibitors (PIs) disable protease, a protein that HIV needs to make more copies of itself.
  • Entry inhibitors work by blocking HIV entry into cells.
  • Fusion inhibitors work by blocking HIV entry into cells.
  • Integrase inhibitors disable one of the proteins that HIV uses to insert its viral genetic material into the genetic material of an infected cell.

HIV-positive people with end stage renal disease (ESRD) who are on dialysis may want to consider a kidney transplant. Doctors can help HIV-positive patients with chronic kidney disease and end stage renal disease determine a treatment regimen that manages both HIV and kidney disease.

Summary

People with HIV or AIDS are at risk of developing kidney disease because of the progression of the AIDS virus and the side effects of the medicines they may be taking to slow this progression. There are several questions HIV- or AIDS-infected people can ask their health care providers about chronic kidney disease (CKD) to help detect kidney problems or health risks early. These questions include:

  • Should I be tested for kidney disease?
  • What kind of test would be best for me?
  • Will my HIV treatment change if I have kidney disease or am at risk for kidney disease?
  • How often should I have my kidneys tested to make sure they are healthy?
  • What can I do to decrease my risk for kidney disease?

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